Medical Benefits Guide

Supporting Your Total Wellness

PPO Plan and HDHP Administered by Aetna

Citadel continues to provide access to comprehensive, competitive medical coverage for you and your family. For 2024, you’ll have the choice of two medical plan options administered by Aetna: the PPO plan and the High Deductible Health Plan (HDHP).

Enrolled participants may contact the Aetna Concierge Service at 800-544-5488 for more information related to these plans.

PPO Plan: With the PPO plan, your paycheck contributions are higher than with the HDHP, but you pay less when you receive care. If you are enrolled in the PPO plan, you can use the FSA to pay for eligible healthcare expenses over the course of the year with pre-tax dollars.

HDHP: The HDHP offers the same comprehensive coverage for you and your family as the PPO plan, with lower paycheck contributions. The tradeoff is potentially higher costs due to higher annual deductibles and higher out-of pocket maximums.

Once you satisfy your deductible in the HDHP, you pay a percentage of the eligible healthcare charges (including prescription drugs) based on the chart on the following page, the plan pays the rest, until you reach your annual out-of-pocket maximum. After that, the plan pays 100% of eligible in-network medical and pharmacy expenses for the remainder of the year.

The HDHP comes with a Health Savings Account (HSA) that provides a tax-free way to help you pay for eligible out-of-pocket healthcare expenses—now or in the future.

Important Considerations When Electing to Receive Services from an Out-of-Network Provider

For both the PPO plan and HDHP, the plan's approved covered charge for out-of-network services is a maximum of 400% of the Medicare-approved rate for any given service. If the approved charge the plan pays to an out-of-network provider does not cover the total cost for service the provider charges you, the provider may elect to "balance bill" you. This means that you may be responsible for the difference between the approved charge the plan pays and the total charge the out-of-network provider elects to bill you. This is not the case with in-network providers for both the PPO plan or HDHP. Innetwork providers have agreed to accept payment from the plan and the in-network provider may not "balance bill" you. Before receiving services from an out-of-network provider, we recommend contacting the Aetna Concierge Service at 800-544-5488 to determine what covered charges the plan will pay compared to the total cost the out-of-network provider will bill you. This will allow you to determine the amount that the plan will not cover and that the out-of-network provider will require you to pay out of pocket.


The PPO Plan and HDHP Plans At-a-Glance

Here’s a quick look at how the PPO plan and HDHP compare. Use the new Smart Select tool to help you evaluate the best plan option to meet your needs for 2024.

   

PPO Plan

HDHP

Monthly Premium Higher Lower
Annual Deductible: In-Network Out-of-Network Lower

$500 Individual / $1,000 family
$1,000 individual / $2,000 family		 Higher

$1,600 individual / $3,200 family
$3,000 individual / $6,000 family
Annual Out-of-Pocket Maximum: In-Network Out-of-Network Lower

$1,500 Individual / $3,500 family
$4,250 individual / $9,500 family		 Higher

$3,000 individual / $6,000 family
$6,000 individual / $12,000 family
In- Network Office Visit/Specialist $25/$40 90% after deductible
Preventive Care 100% 100%, deductible does not apply
Medical/Surgical Services 100% 90% after deductible
Oral Surgery 90% after deductible 90% after deductible
Emergency Room Copay $150** 90% after deductible
Inpatient Hospital Services $250 90% after deductible
Outpatient Hospital Services 90% after deductible 90% after deductible
Out-of- Network Most other covered services 80% after deductible 80% after deductible
  Tax-Advantaged Account Options

Healthcare Flexible Spending Account (FSA)

Contribute up to $3,050, pre- tax per year for current year expenses Unused funds are forfeited each year at the annual deadline Any account balance is forfeited if you leave Citadel No investment options

Health Savings Account (HSA)

Contribute Contribute up to $4,150 (for individual medical coverage) or $8,300 (if you cover any family members) for eligible expenses incurred this year—or save for later expenses. Account rolls over from year to year Account is portable if you leave Citadel You may elect to rollover funds from an existing HSA into your HSA with us. Investment options available after your account balance reaches $2,000


Healthcare Coverage Premiums

Employee healthcare premiums (includes medical, dental and vision coverage) are based on your current annual salary plus your total annual inventive award. Please note that all employee-paid premiums will be deducted every pay period on a pre-tax basis with exception of domestic partner benefits, which, by law, must be paid with posttax dollars.

2024 Employee Premiums Per Pay Period
Coverage

PPO

HDHP
Total Compensation
< $300,000  		 Total Compensation
> $300,000		 Total Compensation
< $300,000		 Total Compensation
> $300,000
Employee Only $59    $125 $29 $62
Employee & One Dependent $124   $271 $62 $135
Employee & Family $174    $380 $87 $190

 

Prescription Drug

Through our partnership with RxBenefits, you have access to a better member experience, including everything from answering coverage questions to resolving complex issues. RxBenefits is staffed by live representatives who are knowledgeable in our pharmacy benefits. In addition, you have access to one of the largest pharmacy networks in the country, CVS Caremark. When you fill a prescription at a participating pharmacy, your share of the cost is based on the type of drug and the medical plan you select as outlined below.

Prescription Drug Plan Overview

Prescriptions Filled Through Network Pharmacy (30-day supply)
Type of Drug

PPO Plan

 HDHP
Generic  $10 copay

You pay 10% after you meet the plan deductible.

Formulary Brand  $30 copay
Non-Formulary Brand Name  $60 copay
Specialty  $100 copay


The Home Delivery Program

This service allows you to receive up to a 90-day supply of maintenance prescriptions by mail and avoid trips to the pharmacy. By enrolling in 90-day refills, you pay the same amount as two 30-day supplies at a retail pharmacy. Medications for short-term illnesses are best obtained at your local pharmacy.

CVS Caremark App

Download the CVS Caremark app from your preferred app store. You can order refills, check status, check costs and coverage, find a pharmacy and more on caremark.com or the CVS Caremark mobile app.

app

To learn more call RxBenefits Member Services at 800-334-8134, or email RxHelp@RxBenefits.com

 

Vision and Dental

If you elect medical coverage through Citadel and Citadel Securities, vision and dental coverage are automatically included.

EyeMed

With its expanded network and commitment to service, our vision plan will be easier to use than prior plans. If you use in-network doctors, you will have no claims forms to file—EyeMed will be billed directly by your doctor. If you use out-of-network doctors, plan maximums apply and you may be responsible for submitting claims for reimbursement.

Vision Plan Overview

Benefit

In-Network

Out-of-Network

Vision Care

Eye Exam
(Including refractions)

100%

$50 reimbursement

Lenses, frames, and contact lenses  

$300 calendar year maximum

$300 calendar year maximum

LASIK

 

 

Lasik or PRK from U.S. Laser Network  

15% off retail cost

Not covered


Delta Dental

We offer dental coverage through Delta Dental of Illinois as described below.

Dental Plan Overview

 

In-Network

Out-of-Network

Annual Deductible

$50*

$50*

Annual Maximum

$2,000*

$2,000*

Lifetime Implant Maximum

$2,000

$2,000

Preventive/Diagnostic

100%

100%**

Basic

90%

90%**

Major

70%

70%**

Annual Maximum

$2,000

$2,000

Orthodontia

50%

50%

Lifetime Orthodontia Maximum

$2,500

$2,500

* Per Person
** Of reasonable and customary charge in a geographical area

Our plan provides reduced out-of-pocket costs by using in-network preferred providers. All oral surgery procedures, except simple extractions, are covered under Aetna.

Enhanced services to individuals with diabetes, who are pregnant or have serious periodontal conditions, are available to those who enroll in the Smile Smart program at deltadentalil.com.


Eden Health

Eden Health provides all employees and their adult dependents (18+ years) access to their concierge healthcare team—available in-person and/or virtually including:

Telemedicine, 24/7

Chat real-time with an Eden Health primary care clinician through the app to get answers to your health and wellness questions, including diagnoses, treatments and prescriptions. You can also schedule a virtual appointment at any time that works best for you through the Eden Health app.

In-Person Primary Care

Select offices will have on-site or near-site clinics available to help with any preventive health, urgent care, or prescription needs. Same- day appointments can be booked through the Eden Health app. For offices that will not have a clinic on- or near-site, Eden Health clinicians will make prescheduled visits to come to those offices and provide primary care services— including vaccinations, testing and more.

Insurance and Bill Advocacy

Eden Health will help you get the most out of your health benefits by ensuring claims with Aetna or your personal insurance are processed correctly. They can also support you with insurance and medical billing question. When needed, Eden Health can also help you find in-network medical providers.


Download the Eden Health App:

download-eden

Fitness Resources

Your overall physical wellness is important. We want to provide you with the resources to get and stay active, and to support you as you build new habits. If you participate in our Fitness Spending Account administered by Health Equity in 2024, you can be reimbursed up to $100 per month for in-person or virtual fitness programs (e.g., Peloton membership) and/or gym memberships. Note: This benefit is available to employees across all U.S. offices.